Your Alzheimer's, Memory Questions Answered

June 17, 2009

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IMPORTANT: The contents of this site are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this site.

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Your Questions Answered

Question: Six months ago we applied for VA benefits for my mother. My dad was a Vietnam veteran, and she has been approved, but the benfits are being withheld due to her incompetence to handle her funds. So now we are in a bind to continue her care, and what are we supposed to do? I am 31 and I don't have the means to pay for it. Are there any other options for financial help? She has absolutely no assets, nothing. Everything they had saved was used when my dad's illness prevented him from being able to work, and she was laid off from her teaching job due to her incapacity to perform her duties there. So the main question is: How do the younger "victims" of this horrible disease, pay for care costs?

Answer: For you, and many families facing Alzheimer's, legal and financial questions can be a significant obstacle. A first important step is to seek legal assistance. You may need to get either durable power of attorney or be appointed conservator for your mother in order to collect her VA benefits. A qualified elder law attorney will advise about this and assist with completing and filing the appropriate papers, which may include an application for Medicaid.

You may want to consult the Alzheimer's Association, Georgia chapter for names of elder law attorneys by calling 800-272-3900 or visting the association's Web site to find an elder law attorney in your area.

Question: How do you know if a person with Alzheimer's is close to the end? Are there signs?

Answer: Most patients will follow a series of changes as they progressively deteriorate as a result of Alzheimer's dementia. Patients in their final months will become less interactive, lose the ability to speak and communicate and become incontinent of both stool and urine. They eventually become bed-bound, as they no longer are able to walk or transfer.

They will no longer remember to eat, and often push food away if fed, and have progressive weight loss. As a result of these changes, they are more susceptible to infections such as pneumonias and urinary tract infections and are admitted to the hospital more frequently.

They may also develop bed sores and contractures (inability to extend and flex their joints). Some individuals become more agitated and disruptive. Other patients become withdrawn. Regardless, in these final stages, these individuals will require total assistance for all of their activities of daily living.

Your Alzheimer's Questions Answered

Question: Can Alzheimer's cause seizures?

Answer: Yes, having Alzheimer's disease is associated with a higher chance of having seizures, even in people who have not previously been epileptic. In my experience, the seizures generally occur in the advanced stages of Alzheimer's disease and are generalized in character, in which the person loses consciousness during the actual event (this type of seizure formerly was known as "grand mal").

In one study, up to 25 percent of advanced Alzheimer patients experienced at least one seizure. The seizures can be treated effectively with currently available anti-epileptic medications. Alzheimer's patients, again generally those who are in advanced stages of dementia, also can develop a seizure-like disorder termed "myoclonus" in which frequent and often widespread muscular twitches occur but there is no associated loss of consciouness. Myoclonus can be treated as well with current medications if necessary, but often the myoclonus is mild and does not require treatment.

There are many possible causes of both seizures and myoclonus in older adults, including those with Alzhiemer's disease. Thus, it is very important to have a thorough evaluation by a physician to assess for the underlying cause or causes of the condition rather than to simply assume that it is attributable to Alzheimer's disease.

Here's an update on the high demand for this test from Dr. Jeremy Brown, a neurologist who helped design the five-minute test:

Thank you for your interest in the TYM (Test Your Memory) test. We have been very pleased with the publication of our initial study and the huge response. I'm afraid not all the publicity concerning the test is accurate. The TYM test is designed to be used as part of a medical consultation not for self-diagnosis.

If you would like to try the TYM test, then your doctor may be willing to supervise the TYM. They can find out more information from the BMJ and TYMTEST websites. It may be a couple more weeks before the TYM website is operational. (This message was posted June 12, 2009.)

Your Alzheimer's Questions Answered

Question: How can I be sure that in diagnosing my mother with Alzheimer's desease the doctors didn't just look for signs to confirm a diagnosis but also ruled out every other desease/illness that may cause similar symptoms? What are some illnesses that may be incorrectly diagnosed as Alzheimer's? I want to be sure that every other illness was not missed by making what may be seen as an "obvious" diagnosis.

Question: My mother was diagnosed with dementia when she was 75 years old. She is now 89 and in late-stage. I have heard that if a person has late-onset dementia that it is less likely to be inherited. In other words, if my mother would have gotten dementia when she was much younger, than my chances of getting it would be increased. There are several people on my mother's side that have had dementia (three of her first cousins). Does that also increase my chance of getting it?

Answer: We have received many questions like this. We suggest those of you interested in learning more about heredity and Alzheimer's take a look at our answers on risk factors and diagnosing Alzheimer's by going to the Alzheimer's question index here.

Question: I heard that dementia can be caused by taking Excedrin PM or Tylenol PM. Is this true?

Answer: We address this question in a story we wrote about sorting out Alzheimer's myths. You can go to the piece by clicking here.

Your Alzheimer's Questions Answered

Question: My 88-year-old mom is now getting extremely combative when her clothes need changing or her hair [needs] washing. She lives at home with my 90-year-old dad. I am her daughter and I help out as often as possible. Any suggestions as to how I can handle her and make the "clean up" during these episodes less confrontational? My dad is from the old school and vows to take care of her till the end, but I think he won't be able to handle her much longer.

Answer:
First of all, the problems you note are very common, but that information doesn't make the problem any easier to deal with. Indeed, most physical and verbal aggression occurs while providing personal assistance to persons with dementia (PwD), and is often a reaction to the perception of threat.

Discomfort (e.g. bath water too cold or hot, arthritis making it painful to put her arm through the sleeve of her sweater, etc.)

Loss of personal control or choice: Do you want to wear the blue dress or the red dress? Preserve the dignity of a simple choice the PwD can make -- not an open ended question like, "What do you want to wear today?"

Lack of attention to personal needs or preferences (e.g. always took a shower at night, now has to be bathed in the daytime).

Unfamiliar routine; uncertainty about what is going on and why.

Feeling unsafe or afraid of the unknown. (Taking clothes off can be terrifying if you no longer recognize who is doing it to you.)

Some things you might look at:

How is your mother taken to the bathing area? Is she appropriately covered before, during and after the bath or shower?

Is the room and water at a warm temperature, is she comfortable and can you play pleasing music in the background or add pleasant smells?

Is pain a problem? Would Tylenol 30 minutes before bathing or dressing help? Are limbs stiff due to meds or disease processes?

Suggestions (some work, some don't):

Focus on the person, not the task.

Use past memories and experiences to encourage cooperation (e.g. "You can't go to church in those clothes, we need to get cleaned up.")

Try bathing/washing hair before getting dressed in the morning as it may reduce resistance to disrobing and feel more natural.

Provide a reason for what you are asking (e.g. "Let's get your bath over with so you can eat breakfast.")

Have the person who is most successful (home care woreker, visiting nurse, spouse, adult child) consistently do the task.

Proceed in a calm, personal, gentle manner. (I know, easier said than done!)

Don't rush. Take time and monitor the PwD responses.

Break each task into small, understandable steps. Cue your mother to help herself whenever possible and how to use washcloth, zippers, toothbrush, etc.

Question: My mother has been taking a statin-based medication for her high blood pressure and we have noticed memory loss. On one of the specials on TV I remember seeing mentioned that statins can contibute to memory loss. Is this true?

Answer: Click here for a link to a story we wrote in 2008 on memory loss and statins.

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Question: My Mother had a TIA (transient ischemic attack) stroke in 2004, and on March 25, 2009 she had a stroke, and now it looks like she is getting Alzheimer's -- she cries and sometimes does not recognize me (her daughter), and after sundown she gets depressed. My question is: Should I get her started on some kind of Alzheimer's medicine? My mother is 87 years young.

Answer: Dear OnCall+ user, it sounds like you are responsible for making the health care decisions for your mother. I am sure it must feel overwhelming at times. First and foremost I would suggest that you make sure your mother has a primary care doctor whom you feel comfortable with, who knows your mother and who is experienced in caring for elderly patients.

Because of your mother's behavioral problems, including her agitation and confusion at night (your refer to sundowning), your doctor will recommend that she have an evaluation to be sure she has no additional medical problems such as side effects from medications, thyroid problem or other underlying kidney or liver disease.

She should also have an evaluation to understand better what is the cause of her changes in behavior and whether or not she has dementia. I would not recommend she start any new medication(s) until she has had an expert physician review all the possible problems and talk with you about possible solutions.

Although I am not in a position to make a diagnosis, it sounds like your mother may have a type of dementia referred to as vascular dementia. I say this because of her history of both a TIA and later a stroke. We now understand that factors that effect the circulation to the heart also are important to the brain as well.

Ideally, your mother's blood pressure, her blood lipids or blood fats, and blood sugar should all be monitored and treated to make sure they are as close to the optimum as possible. Controlling these factors can help slow down the process of dementia. If there are no contraindications, a daily baby aspirin is often recommended.

Finally, your mother should be encouraged to walk and get as much regular physical activity as she can, which is often hard because of arthritis and other aging conditions.

Question: My wife's short term memory has seemed to deterioate and she had problems following recipes or organizing her tasks. She fears she is developing alzheimers. We would like to get her diagnosed but don't know where to start.

Your Alzheimer's Questions Answered

Question: My wife died of early-onset Alzheimer's disease (in her 40s) on Dec. 5, 2008. (This was confirmed by autopsy.) Her uncle was diagnosed with senility in 50s. What is the risk of early-onset Alzheimer's disease, familial-type, for my four children?

Answer: While no one should determine the risk without a thorough family history and examination and review of the causes of dementia, the pattern of family history that is most likely to be highly heritable includes multiple cases of dementia within each generation.

Of note you have described only one case in each generation. If someone is seriously concerned they may benefit from a frank discussion with their own doctor, who may recommend additional evaluation by a dementia specialist or a genetic counselor

Question: Spouse Alzheimer's is so much worse than parent. You can visit and leave the parent. Spouse issues are there 24/7. My husband is diagnosed with MCI but has not deteriorated as quickly. How does one deal with the memory loss, thought connections, anger, and denial and still maintain any kind of a loving relationship?

Answer: No one particular relationship with the caregiver is inherently "worse" than another -- adult child caregivers may be torn between the needs of the parent and their offspring, which can be very challenging as well, or the need to provide "long-distance" care.

That said, my response to the stressed spouse caregiver is: You are not alone. There are many resources available through the Alzheimer's Association, NIA ADEAR, BannnerHealth in Phoenix, Mather Liefeways foundation, etc. that provide help and assistance.

Get respite locally and make time for yourself, join a support group and share your challenges with others who have or are going through similar experiences. Above all, take care of yourself and ASK FOR HELP from family, friends and neighbors with this most difficult task.

Your Alzheimer's Questions Answered

Question: My mother has dementia. How many stages are there for the disease?

Answer: The Alzheimer's Association has posted a list of stages on its web site. They are as follows:

Stage 1: No impairment

Stage 2: Very mild decline

Stage 3: Mild decline

Stage 4: Moderate decline

Stage 5: Moderately severe decline

Stage 6: Severe decline

Stage 7: Very severe decline

You can also click here for more on the various Alzheimer's stages from Mary Sano, Ph.D., Director of the Alzheimer's Disease Research Center at Mount Sinai Medical Center.

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Question: Do you have tips for teenager and young child who are dealing with their father's early early onset of age 45? Communication can be difficult at times.

Answer: Here are some suggestions from Dr. Gary Small, Director of the UCLA Center on Aging:

- Learn about the reality of the disease so you don't take any behavior changes personally.

- Be patient. Slow down your speech and help your relative to focus his/her communications.

- Try to spend time with your relative doing things that you always liked to do together such as taking walks or playing tennis. Over-learned behaviors that they've done for a long time are easier for Alzheimer's patients.

- When your relative gets frustrated, don't respond with anger or become defensive. Stay calm and realize that it's frustration with the disease, not with you.